Individual
DR. TARA GRAVENSTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
300 N 4TH AVE E STE 200, NEWTON, IA 50208-3179
(641) 792-2112
(641) 792-8484
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
52087
SC
207Q00000X
Family Medicine Physician
Primary
DO-05909
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO-05909
FAMILY PRACTICE
IA
Enumeration date
05/11/2015
Last updated
12/02/2021
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